Hodgkin lymphoma

The lymphatic system is part of the immune system and includes your lymph glands and organs such as the spleen. Its functions include:⁴

• Maintaining fluid balance and removal of cellular waste
• Absorbing and transportation of nutrients
• Production of immune cells to help fight infections 

The lymphatic system contains white blood cells called lymphocytes.³ Hodgkin lymphoma starts in these lymphocytes and causes abnormal lymphocytes, which typically reside in the lymph glands.^1,2

There are two main types of Hodgkin lymphoma, classical Hodgkin lymphoma (CHL) and nodular lymphocyte predominant Hodgkin lymphoma (NLPHL).⁵

Within CHL, there are four subcategories:^2,5

• Nodular sclerosis Hodgkin lymphoma
• Mixed cellularity Hodgkin lymphoma 
• Lymphocyte-rich classic Hodgkin lymphoma
• Lymphocyte-depleted Hodgkin lymphoma 

Nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) - generally regarded as being rare, tends to be slower growing (than classical Hodgkin lymphoma), and occurs more in males, usually young to middle-aged.^2,5

Hodgkin lymphoma symptoms can be minimal or vague.² The most common symptom tends to be painless swelling in a lymph node, in for example the neck, armpit or groin.² Other symptoms may include:²

• Fever
• Night sweats
• Unexplained weight loss
• Fatigue
• Persistent coughing
• Shortness of breath
• Itchy skin

Some symptoms of Hodgkin lymphoma are referred to as ‘B symptoms’ and may include:²

• Frequent, unexplained fevers
• Regular night sweats that leave you drenched
• Losing large amounts of weight very quickly

Having any of these symptoms doesn’t mean you have Hodgkin lymphoma, but you should see your doctor for a check-up.

It’s not known what causes Hodgkin lymphoma.^1,2 However, some factors appear to increase the risk of getting the disease, including:⁶

• Genetics
• Family history
• Certain viruses - the Epstein-Barr virus which causes glandular fever, and HIV are associated with a minority of Hodgkin lymphoma cases
• Weakened immune system
• Smoking
• Obesity

If you have one or any of these symptoms it doesn't mean that you have Hodgkin lymphoma. If you have any questions or concerns please speak with your GP or specialist.

A range of tests may be performed to analyse symptoms, to diagnose Hodgkin lymphoma, and to determine the disease stage.² Following a physical examination, which may include an assessment of any swelling in lymph nodes in the neck, underarm and groin, further tests may include:^2,7

• Blood tests 
  
• Imaging tests - these may include magnetic resonance imaging (MRI), computed tomography (CT) scan, ultrasound, or a positron emission tomography (PET) scan of the body to check for tumours and if they have metastasised (spread to other areas of the body)
• Biopsy - is considered to be the most common test for Hodgkin lymphoma. Some of the tissue from an enlarged lymph node is removed for analysis
• Bone marrow biopsy - on occasion, a bone marrow biopsy may be performed to analyse whether there are any cancerous cells present in the bone marrow

Other treatments may include:²

• Immunotherapy
• Stem cell or bone marrow transplant 
• Steroids
• Targeted therapy

Cancer treatment often results in side effects, yet the type and severity of side effects may vary between individuals.^8,9 You can ask your doctor for detailed information about side effects and how to best manage them.

The following list may help when researching the types of activities and nutrition you can consider during treatment.¹⁰ Your treating doctor can also provide further information or point you towards the right resources:

• Get as much rest as possible
• Aim for a wholefood, varied diet, and we also encourage you to think about eating foods that interest you rather than what you think you should eat
• Appetite changes are common, and you may experience taste changes or nausea. Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous
• Drink lots of water
• Reach out to support groups and others who have had cancer treatment
• Record your side effects in a diary or journal
• Speak to your doctor about incorporating some gentle exercise into your weekly routine
• It is important to acknowledge when you are fatigued and rest when you need to
• Ask for and accept help from family, friends and neighbours
• Be open with employers about your treatment and discuss flexible working options if you need them